소 간세포암의 전산화단층촬영 소견 - 조영제 증강 전후 소견의 비교검토 -

김정룡(Chung Yong Kim),이효석(Hyo Suk Lee),최병인(Byung Ihn Choi),한만청(Man Chung Han),김수태(soo Tae Kim),김주완(Chu Wan Kim),김용일(Yong Il Kim),이건욱(Kuhn Uk Lee) 대한소화기학회 1988 대한소화기학회지 Vol.20 No.3

N/A Sixty-seven lesions of small hepatocellular carcinoma in 50 patients under 5cm in diameter detected by computed tomography (CT) were reviewed to characterize the CT feature. All 50 patients were studied with a CT-9800 scanner. CT scans were obtained both before and after administration of contrast medium given by bolus injection of 120 ml of meglumine iohatlamate. CT density of the tumor was classified as hypodense, isodense, and hyperdense on the basis of the difference in density between the lesion and the surrounding liver parenchyma. Detectability of small hepatocellular carcinoma on CT scans was divided into three categioies; Good: tumor is noted, and extent of tumor is clearly defined; Fair: tumor is noted, but extent of tumor is not defined; Poor: tumor is not noted. On nonenhanced CT scans, 40 cases (60%) showed hypodense masses and 27 cases (40%) showed isodense masses whereas all cases showed hypodense masses on contrast-enhanced CT scans. On nonenhanced CT scans, 27 cases (40%) were categorized as good, 13 cases (20%) as fair, and 27 cases (40%) as poor while 65 cases (97%) were categorized as good, and 2 cases (3%) as fair on contrast-enhanced CT scans. Additional CT characteristics of small hepatocellular carcinoma were well defined margin (99%), and peripheral hyperdense rim (44%). These results suggest that contrast-enhanced CT scans are better than nonenhanced CT scans in detecting and defining the tumor, and CT might be useful for characterization of small hepatocellular carcinoma.

췌장의 림프상피성 낭종

윤용범(Yong Bum Yoon),김정룡(Chung Yong Kim),박용현(Yong Hyun Park),김용일(Yong Il Kim),김우호(Woo Ho Kim),김선희(Sun Whe Kim),김재규(Jae Gyu Kim),한준구(Joon Koo Han) 대한소화기학회 1997 대한소화기학회지 Vol.30 No.4

Cystic lesions of the pancreas can be histologically classified into several distinct categories including pseudocyst, congenital true cyst, acquired true cyst, and cystic neoplasm. A lymphoepithelial cyst of the pancreas is a distinctive lesion characterized by the presence of mature, keratinizing squamous lining surrounded by lymphoid tissue and is reported mostly as a single case. We report the first case of a lymphoepithelial cyst of the pancreas proven histologically in Korea. A 60-year-old woman presented a pancreatic mass. Six months ago, a 5 to 10 mm multiple papular skin rash developed and was associated with fever and pruritus. Thereafter, jaundice, fatigue, and anorexia developed. These symptoms and signs resolved spontaneously 20 days later. At that time, ultrasonography of the abdomen demonstrated a 4.5 cm predominantly cystic mass arising from the body of the pancreas. Her past medical history indicated no alcohol intake, gallbladder disease or previous pancreatitis. On admission, physical examination of the abdomen was unremarkable. Serum amylase and the liver function test were also unremarkable. Serum CEA was 9.2 ng/mL. Computed tomography of the abdomen showed a 4.5 c cystic low attenuation mass in the body of the pancreas. Fine needle aspiration was performed. The CEA was 1252 ng/mL and amylase was 2840 U/dL. The cytologic examination revealed some degenerated epithelial cells and lymphocytes. At laparotomy, a smooth, encapsulated, well-circumscribed mass was found in the body of the pancreas. The mass did not invade the pancreas or other adjacent structures. The mass was completely excised. The specimen consisted of a 4 cm thin walled cyst filled with yellowish fluid. The lining was smooth and trabecular in part. Microscopically, the cyst was lined by a squamous epithelium and the epithelial lining was surrounded by lymphoid tissues with scattered germinal centers. (Korean J Gastroenterol 1997; 30:559-563)

간세포암의 전산화 단층촬영 소견

김정룡(Chung Yong Kim),최병인(Byung Ihn Choi),한만청(Man Chung Han),김수태(soo Tae Kim),박경주(Kyung Joo Park),이병희(Byung Hee Lee) 대한소화기학회 1987 대한소화기학회지 Vol.19 No.1

N/A A retrospective review of CT finding was undertaken from 89 patients who had hepatocellular carcinoma confirmed by histopathologically or clinically. In morphologic classification, solitary type was the most frequent one (43 cases) followed by multinodular type (27) and diffuse type (19) in order of frequency. Bulging of liver contour due to tumor was seen in 45 cases (50%). Size of the tumor in solitary type (43 cases) was mostly larger than 3cm in diameter except 6 cases. 44 cases were located in the right lobe, 19 cases in the left lobe and the remainder involved both lobes. Pre-contrast CT revealed the tumors in the 57 cases (64%) out of 79 cases in which pre-contrast CT was performed, however, detection rate increased up to 98% (87 out of 89 examinations) in post-contrast CT. A majority of tumors showed low density in both pre-contrast CT (64 cases) and postcontrast CT (85 cases) and 3 tumors had calcification in the lesion. 22 cases (25%) showed portal vein invasion in CT and regional lymph node enlargement was demonstrated in 24 cases (27%). Variable cirrhotic pattern was noticed in 55 cases (62%) of hepatocellular carcinoma.

간장 ( 肝臟 ) · 담도 ( 膽道 ) 및 췌장 ( 膵臟 ) : 고 - 고빌리루빈혈증을 보인 간실질 질환 및 담도 폐쇄 환자들의 단기 예후

김정룡(Chung Yong Kim),이효석(Hyo Suk Lee),정숙향(Sook Hyang Jung) 대한소화기학회 1991 대한소화기학회지 Vol.23 No.4

N/A Serum bilirubin level seldom exceeds 30 mg/dl in the patients with complete extrahepatic biliary obstruction. Therefore, hyper-hyperbilirubinemia which is defined as hyperbilirubinemia above 30 mg/dl of serum bilirubin level is rarely found only in patients with accompanying pigment overload or renal failure in addition to preexisting parenchymal liver disease or biliary obstruction. In this study, shor-term prognosis of 85 patients with hyper-hyperbilirubinemia were evaluated according to the underlying hepatobiliary diseases and precipitating factors. Of 85 patients, 57(67%) were patients with primary parenchymal liver diseases which included 2 cases of acute hepatitis, 4 cases of toxic hepatitis, 5 cases of chronic viral hepatitis, 23 cases of cirrhosis, 22 cases of primary liver cancer, and 1 case of alcoholic liver disease. Seventy six patients (89%) showed clinical deterioration of which 30 terminated to death and 46 were subjected to hopeless discharge. Only 9 patients (11%) were clinically improved during hospitalized period. Most of the survived patients had acute liver diseases, suggesting that preexisting liver disease was important in the determination of short-term prognosis. Analysis of precipitating factors revealed that 96% of patients had either pigment overload or renal failure. All patients except one, who had renal failure with or without pigment overload showed clinical deterioration. Of 21 patients having only pigment overload without renal failure, 8(38%) showed clincial improvement. We concluded that the patients with hyper-hyperbilirubinemia super- imposed on preexisting acute liver disease because of pigment overload had better prognosis than those with hyper-hyperbilirubinemia because of renal failure.

절제술을 시행한 원발성 간세포암 100 예의 임상연구

김정룡(Chung Yong Kim),김수태(soo Tae Kim),안세현(Sei Hyun Ahn) 대한소화기학회 1985 대한소화기학회지 Vol.17 No.2

N/A This paper describes a clinical analysis of 100 patients who underwent hepatic resection for primary hepatocellular carcinoma at the Department of Surgery, Seoul National University Hospital during the past 7 years, from Sep. 1978 to Aug. 1985. The results were as follows: 1) The sex ratio of male to female was 4.6: 1 with the predominancy in the 5th and 4th decades(73%). 2) The HBs-Ag positive rate was 71.4g and 98.5g of HBs-Ag or antibody positive rate. 3) It was 75.8% of aFP positive rate (above 20 ng/ml), and there was no correlation between aFP level and tumor size. 4) Massive hepatic resection was performed in 42.6% of cirrhotic patient and 65.5% non cirrhotic patient. 5) Cirrhosis was accompanied in 61% of patient, and there was no difference in the operative mortality between the cirrhotic and non cirrhotic group. 6) By Childs classification, the operative mortality and 1 yr, 3 yr survival rate was 5.1% 60% 41% in A group, 26% 48% 24% in B group, and 50% 0% 0%. In C group (p<0.05) 7) There was no relation between the survival and tumor size. 8) The overall operative mortality was 11% 9) The 1 yr, 3 yr survival was 57% 36% for all patient and 49% 32% for cirrhotic patient and 70% 44% for non cirrhotic patient (1yr; p>0.05, 3 yr;p< 0.05). 10) Curative resection was porformed in 64% of patients. It was 68.0% and 38% of 1yr, 3yr survival for patient of curative resection, and 37%, 2% for palliative resection (p< 0. 05).

한국인에서 하공정맥폐쇄의 병인으로서 막양폐쇄의 중요성

김정룡(Chung Yong Kim),정현채(Hyun Chae Jung) 대한소화기학회 1988 대한소화기학회지 Vol.20 No.1

N/A Patients with inferior vena caval obstruction confirmed by venography for the past 13 years in Seoul National University Hospital were analyzed as to their etiology. Especially among them, surgically correctable membranous obstuction of the inferior vena cava were assessed as to their frequency, clinical manifestations and laboratory findings for early detection. 1) Of 48 patients with inferior vena caval obstruction, mernbranous obstruction were noted in 28(57%), tumors in 9(18%), others in 11(23%). 2) Symptom duration (9.8 years), frequency of the hepatomegaly and the splenomegaly (71%, 43%) of membranous obstruction was longer and higher than that of turnor and others (p<0.01). 3) Frequency of thrombocytopenia of membranous obstruction was higher than that of tumor and others (57%, p < 0.02). 4) Surgical correction was possible in 8 patients with membranous obstruction, arnong them, 7 patients experienced improvement of clinical symptoms and laboratory findings. In conclusion, membranous obstruction was the most important etiology of inferior vena caval obstruction in Korea. For early detection of surgically correctable cases, when the typical symptoms of inferior vena caval obstruction were accompanied by the symptoms of portal hypertension (e.g. hepatosplenomegaly, thrombocytopenia and esophageal varix), aggressive diagnostic approaches including inferior vena cavography must be needed.

간의 원발성 림프종

김정룡(Chung Yong Kim),이효석(Hyo Suk Lee),김용일(Yong Il Kim),김재준(Jae Jun Kim),최병인(Byung In Choi),윤병철(Byung Chul Yoon),남택서(Taik Seo Nam),백경란(Kyong Ran Pack) 대한소화기학회 1990 대한소화기학회지 Vol.22 No.2

The primary lymphoma of the liver is a very rare disease. We report a case of primary lymphoma of the liver in 41-year-old male patient who had 7 month-history of right upper quadrant abdominal pain, bulging mass, fever and weight loss. He had been hospitalized twice to local general hospital where metronidazole was give for 10 and 30 days under the impression of amebic liver abscess. On the physical examination, smoothly bulging mass (diameter 15cm) was found on the abdomen, and the liver was palpable about 20 cm below the right subcostal margin. There was no palpable lymph node and splenomegaly. All of laboratory findings including CBC, LFT, alpha-fetoprotein and CEA were within normal range except aikaline phosphatase which was markedly elevated up to 319 U/L. CT -of abdamen showed huge multiloculated solitary mass with necrotic portion in the center. The mass was not enhanced with contrast dye. Both portal veins were displaced by the mass, but not invaded. The characteric findings which gave diagnostic clue were the enhanced intact portal veins inside the mass. Laparotomy disclosed a large mass extended on both lobes. Splenomegaly or lymph iode enlargement was not found. Right lobectomy was done. The pathologic finding was that of malignant 1ymphoma, diffuse large cell type of NCI working formula.

모형 담즙과 담낭 답즙에서 콜레스테롤 핵형성 촉진 인자로서의 Phospholipase C 의 역할

김정룡(Chung Yong Kim),김용태(Yong Tae Kim),윤용범(Yong Bum Yoon) 대한내과학회 1995 대한내과학회지 Vol.49 No.1

N/A Objectives: There are a number of proteins that may influence cholesterol nucleation in bile, Recently, phospholipase C has been suggested as a nucleation-promoting factor in human gallbladder(GB) bile. However, it is not known whether there is a quantitative difference in phospholipase and normal controls, and whether suppression of phospholipase C in human GB bile might alter the nucleation time. So we tried to investigate the role of phospholipase C as a cholesteol nucleation-promoting factor in model bile and in human GB bile. Methods: To determine if phospholipase C has a capacity to promote nucleation of cholesterol in model bile, nucleation times were compared among model biles which were mixed with serially diluted phospholipase C(0, 10, 100, 1,000, 10,000, 100,000 U /L). To investigate if phospholipase C is a main promoting factor of cholesterol nucleation in human GB bile, nucleation times and phospholipase C activities in GB bile were compared among patients with cholesterol gallstones(n=12), pigment gallstones(n=12), and controls(n=7). The influence of suppression of phospholipase C by EDTA(2 mM) on the nucleation time in GB biles of patients with cholesterol gallstones was also studied. Phospholipese C activity was measured by the release of phosphoryl [H3] choline from the substrate 3H-phosphatidylcholine after delipidation by gel chromatography. Results: Phospholipase C decreased the nucleation time of model bile in a dose dependent way from more than 21 days to 5 days, but the activity in human GB bile was elevated more than that of the controls in only 17% of patients with cholesterol gallstones. Suppression of phospholipase C activity by EDTA did not prolong the nucleation time of the GB bile of the patients with cholesterol gallstones. Conclns1on: Phospholipase C has a capacity to decrease the nucleation time in model bile but it does not play a significant role in cholesterol gallstone formation in human GB bile.

성인 남자에서 발견된 다발성 간세포 선종

김정룡(Chung Yong Kim),이효석(Hyo Suk Lee),박재형(Jae Hyung Park),김용일(Yong Il Kim),김종민(Chong Min Kim),이준혁(Joon Hyuk Lee) 대한소화기학회 1990 대한소화기학회지 Vol.22 No.2

Hepatocellular adenoma is a very rare benign tumor of the liver in male. The most of them were single. We experienced a multiple hepatocellular adenoma in a young male with the serum biochemical findings compatible with the glycogen storage disease. CT scan revealed 6 nodular masses homogeneously enhanced after the injection of contrast medium. The histologic diagnosis was confirmed by peritoneoscopic needle biopsy of the liver. Subsequent arterial embolizations with lipiodol and gelfoam particles reduced the sizes of the nodules.

혈청 Alpha - Fetoprotein치가 높으면서 ( 400ng / ml 이상 ) 간초음파상 종괴소견이 없는 만성간질환 환자에서 s - ALT 및 s - AFP 치 비교관찰의 진단적 의의

김정룡(Chung Yong Kim),이효석(Hyo Suk Lee),최병인(Byung Ihn Choi),김나영(Na Young Kim) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.3

N/A In practice, we sometimes encounter the patients with chronic liver disease (CLD) who showed serum alpha-fetoprotein (AFP) above 400 ng/ml and no mass lesion in the liver on ultrasonogram. We enrolled 58 such patients, on whom abdominal CT and hepatic angiography were performed to determine the accompanying rate of superimposed HCC. The initial serum ALT level and the subsequent changes of serum AFP levels of the patients with superimpoaed HCC were compared to those of the CLD patients without superimposed HCC to investigate the usefulness of these tests as simple and noninvasive diagnostic tool, which might replace the expensive and invasive tests such as abdominal CT and hepatic angiography. Among 58 patients enrolled, 27 patients (46.6%) were complicated by superimposed HCC, while 31 patients (53.4%) were CLD patients without superimposed HCC. The sensitivity and specificity of serum ALT level below 87 IU/L ( * 3 of upper normal limit) for the detection of HCC were 85.2% and 80.6%, respectively. Out of 31 CLD patients uncomplicated by HCC, the subsequent AFP levels in 24 decreased in a month by 50%. In contrast, 10 CLD patients compIicated by HCC whose subsequent serum AFP levels were checked, showed elevation or no-change of AFP levels, but not decreased at all in a month. We conclude that more than half of the CLD patients with serum AFP above 400 ng/ ml and no mass lesion in the liver on ultrasonogram had not been complicated by HCC, and the initial ALT level and the subsequent serum AFP in 2-4 weeks will be useful as simple and noninvasive exclusion diagnostic tool for the differentiation of CLD complicated by HCC.